{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Brown","gend":0,"currentgend":"","add":"12 DROWNE RD APT 120","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1933-07-31","age":"","mstatus":"","insh":"00007665600","cliId":"","pno":2073830226,"cno":"","email":"dbrown7016@gmail.com","ename":"","eno":"","pphy":"ZAGER, SAMUEL","ppno":2078282402,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 DROWNE RD APT 120","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2078287850,"pcpnpi":1821383860,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CR1JV9JV90","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L84","E1142","E1159","L03114","H53131","E1149","N200","C61","M1711","L819","Z87440","N401","N138","N3090","E1140","N179","N189","R5383","N390","E1129","E1136","E1151","R519","K921","Z87891","Z7982","I2510","B351","M79674","M549","H40023","R0600","E119","R0609","Z4802","G459","I10","I351","E039","I110","R0602","D539","R000","R4701","R4182","Z23","R531","S61412A","W010XXA","R002","I453","I700","I4710","I440","I6523","M25561","R0789","H5461","H31011","H43812","G319","R9089","I499","J189","M79675","H26492","Z87442"],"date":["2023-06-21","2024-01-10","2024-01-10","2024-10-16","2025-09-15","2024-01-10","2024-05-13","2025-10-20","2025-09-24","2025-11-11","2025-09-17","2025-10-20","2025-10-20","2025-08-04","2025-10-27","2025-07-07","2025-07-07","2025-07-07","2025-07-07","2025-04-28","2025-04-28","2025-04-28","2025-06-10","2025-11-12","2025-11-12","2025-11-12","2025-10-10","2024-01-10","2024-01-10","2023-02-22","2025-09-15","2023-11-27","2025-03-17","2024-12-22","2024-10-21","2025-06-15","2023-12-12","2024-01-12","2025-10-27","2025-09-03","2023-11-27","2025-07-28","2023-12-20","2025-05-14","2025-05-14","2025-11-03","2025-06-27","2024-10-11","2024-10-11","2024-06-11","2022-12-08","2022-12-08","2023-12-20","2023-12-20","2025-05-14","2025-06-24","2023-12-06","2024-08-27","2024-08-27","2024-08-27","2025-05-14","2025-05-14","2023-12-07","2022-11-03","2022-11-16","2022-09-22","2022-08-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","RELION PRIME TEST STRIPS","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}